People with persistent Afib. How do you get on with exercise?

I used to have paroxysmal afib and never had a problem with exercise. I used to run quite often and over several years I completed a couple of half marathons and a full marathon (I don't mean it took several years to complete them!).

I started running again earlier this year but noticed that, even after a short run, I would feel stressed and my heart would be all over the place. I have since been diagnosed with persistent Afib and now find that even a brisk walk seems to heighten my Afib symptoms!!!

Does anyone with persistent Afib have any tips/advice?


34 Replies

  • Hi joebob

    All I can really say is take it easy, I can exercise but need to rest much more often and use a Heart Rate Monitor to ensure I do not send the heart rate too high. But yes get tired very quickly, although I don't actually get any worse symptoms, but do have to be reasonably careful.

    Be well


  • Hi joebob

    All I can really say is take it easy, I can exercise but need to rest much more often and use a Heart Rate Monitor to ensure I do not send the heart rate too high. But yes get tired very quickly, although I don't actually get any worse symptoms, but do have to be reasonably careful.

    Be well


  • I have been advised that AF is no reason not to exercise, but every attempt I have made at resuming has put me back in hospital and made my AF worse. I suspect that the people who can exercise may be the ones who's AF doesn't feed through the AV node and cause ventricular tachycardia, or perhaps they're the ones whose AF wasn't caused by exercise in the first place. At the moment there are various hypotheses about how exercise may increase the risk of AF, but until there's a causal mechanism identified were not very likely to know much more about it. Heidbuchel et al published a paper finding that the long term success rate of an ablation is halved in those who don't give up exercise, and concluded:

    “It seems prudent to counsel [AF patients] on the possible pro-fibrillatory effects of extensive endurance sports activity. Reducing sports activities may need to be considered........weighed against the well known benefits of cardiovascular effects of exercise in general."

  • I think they are referring to extreme exercise - this causes fibrosis in athletes and electrical signals can be transferred erratically more easily with fibrosis- if athletes stop activity he heart muscle reverts to normal. I think moderate exercise is good and important but as everyone says don't overdo it!

  • It depends what you mean by extreme really, with heavy exercise Mont et al found that the risk was 6 times with just a few hundred hours of light sweating, and 23 fold with 6000 lifetime hours. With heavy exercise it only takes a few hundred hours to increase the risk seven fold. I have clocked up about 8300 lifetime hours, much of it at an ill judged pace as the result of ignorance and advice to ignore my symptoms and get more exercise. I can see now that I have been living with chronic fatigue for so long I had become incapable of recognising it. With overtraining syndrome too, there is a common belief that it only applies to elite athletes, but this is not the case. In 2011 Matos et al found that low intensity sports such as golf were more prone to OTS, possibly they are less careful if they believe they aren't at risk. Matos also found that people who have few interests outside their sport are more prone, again they presumably are likely to spend more time active.

    Moderate exercise is certainly good for you, being a couch potato incurs roughly the same risk as smoking, but anyone with an interest in an active pastime will find it easy to exceed the exercise recommendations for good health.

  • Looks quite restrictive then?

  • It is a relief to find someone who recognises the effects of AF and not blithely trot out standard wisdom when it is so contrary to personal experience. Not everyone will be exercise intolerant with AF but I have found I am now and many people on this site report it too (although many do not). It has been quite devastating to reduce my activity levels and on top of that to get the impression that it is mind over matter adds to the distress. I have openly declared my days of running and walking at altitude finished, I have yet to be reassured that it might not kill me. I can only assume that others do not have the severity of symptoms to be so confident otherwise. Post exercise and when reverting to NSR from fast AF is the only times I suffer from pre-syncope. I can endure the fatigue and episodes of fast AF (up to and sometimes above 200 bpm) that seems to excite the medics but that is something else and feels potentially life threatening if I pass out without a pulse whilst alone. Above all else I think everyone has to listen to their own body and don't ignore their own feelings, if it feel ok it probably is if not then consider replacing activity with something less demanding.

    Keep well.


  • I've made myself worse and worse by following the NHS advice to ignore my symptoms and get more exercise. My experience fits with all the research I'm reading, and directly conflicts with what the doctors are telling me. The NHS have a record of systematically lying, they have a motive for denying that my AF has anything to do with exercise, and for the first 8 months they started off by denying that I had even been taken to A&E and diagnosed.

  • It's a shame as I really do miss going for a jog :-(

    I'm not going to give up completely though. I'm definitely stating to feel some positive effects from the Amiodarone so I'm going to start doing some long walks and see how I cope. I don't think I have AF as bad as some describe on here, as I don't feel constantly tired etc.

  • Whilst searching for the article Ectopic1 mentioned I found one that said running increases AF by 53% and walking reduces it by 48%, I am really looking forward to walking more when I've had my ablation. Find the right company and place and walking is truly rewarding. :-)


  • Hi Jo, Just work back up very slowly... my experience was going too fast too quickly. And that wasn't even running! The advice I give my clients with physical training is: whatever your choice of exercise, at an easy pace and after 3 days with no adverse effects you can increase and then do the same 2-3 days without a negative effect. In this manner one is sure to not have just had a lucky day or a bad one but you have time tested results prior to increasing the exercise. I wish I took my own advice more often!

    The frog jumping up two and falling back one can be an AF scenario if you go too fast.

    Best wishes

  • Thanks. Due ablation on 8th November (hope it goes ahead this time) and then I can plan how to rebuild my life and fitness. No doubt I will regale you all with how it goes.


  • I'm back on the treadmill but taking it easy and no running. Compared to last year when I could run quite easily for 20 mins I tried it the other day and was shocked to find I couldn't even jog for one minute let alone 20 mins!! My fitness is absolutely rock bottom at the moment :-( even after my PVIs my heart is not quite the same anymore...there is a definite difference...or perhaps I'm just getting old....

  • I think it's just that your heart has to recover Loo- I could hardly walk up a slight hill for 3 months after my first really vigorous AF episode and I now can swim etc-

  • I have been in persistent AF since about May this year. EP -seen this week -is going to write to Cardio to suggest they put me on the treadmill to see how I fare......I walk about 2miles (flat) 3-4 days a week and can cycle too....easy pace...but I do get tired.....

    He said it may give me confidence to exercise more!!! I will let you know the outcome, Joebob....don't forget we are all different.

  • Since being randomly diagnosed 2 years ago I have been in AF permanently.

    I used to walk 1 -2 miles everyday but on diagnosis was prescribed 2.5 mg bisoprolol. This was reduced to 1.25mg after a few weeks. Even on this low dose I was out of breath and really struggled to go up a small incline. After 5 months, when I couldn't walk up hills - my legs just wouldn't go any further, I changed to Diltiazem. Now I walk around 4 -5 miles most days - often quite brisk. Maybe discuss a change of meds with your Doctor until you find one that suits you better.

  • When I first went on the meds last year, my cardiologist said that he was putting me on Diltiazem because it would have less effect on my exercising.

  • Yes perm AF 12 years or more. Despite trying for many years to improve my fitness levels, through walking and gym reclining bikes I have never been able to improve my ability to either increase the distance or reduce the complete exhaustion I get after more than 40 mins of flat walking. If an incline of any order is included that reduces time by 70%.!!

    (Bisop 2.5mg)

    Age: 65

    3 cardioversions none worked for more than 2 days.

    On the subject of ablation, it is known that it is more difficult to revert perm AF to NSR, but I read now about newer techniques using robotics and contact force catheter, giving very good first time results.

    Has anyone any more info on this in the UK? Is the technology used and approved for use here?

  • I had 24/7 AF so assume that what is meant by persistent. That was 10 years ago and I could hardly stand, let alone do any exercise. But my EP found drugs that worked great on me so I was back to being 95% normal. Then had an ablation after a couple of years which was successful, and was back to being 100% normal, cycling, hill walking, anything.



  • Hi Koll, can I ask what medication you had? Are you now not in persistent AF?


  • I don't know if "persistent" is a technical term, I know "permanent" can be a technical term. But whatever you call it, I had AF round the clock, all day, every day, so I assume that's what is meant by persistent? But I wasn't persistent for too long, a few months at a guess but it slowly built up to that.

    Anyhow, I was tried on various drugs ending up with Propafenone (brand Arythmol) and it worked perfectly for me. But we're all different so not sure that tells you anything. Most people seem OK on Flecainide but I'm not, etc etc.


  • I thought I was in persistent AF, but I have it 24/7 which, I only found our earlier, is classed add permanent AF.

    There is a persistent AF though, but it's like the paroxysmal AF but sticks around for days/weeks before abating.

  • In the ESC guidelines on catheter ablation, Calkins et al define the categories as follows, but I don't know whether these definitions are universally accepted:

    Atrial Fibrillation Episode:

    An atrial fibrillation episode is defined as AF which is documented by ECG monitoring and has a duration of at least 30 seconds, or if less than 30 seconds, is present continuously throughout the ECG monitoring tracing. The presence of subsequent episodes of AF requires that sinus rhythm be documented by ECG monitoring between AF episodes.

    Paroxysmal AF:

    Paroxysmal AF is defined as recurrent AF (≥two episodes) that terminates spontaneously within 7 days. Episodes of AF of ≤48 hours’ duration that are terminated with electrical or pharmacologic cardioversion should also be classified as paroxysmal AF episodes.

    Persistent AF:

    Persistent AF is defined as continuous AF that is sustained beyond seven days. Episodes of AF in which a decision is made to electrically or pharmacologically cardiovert the patient after ≥48 hours of AF, but prior to 7 days, should also be classified as persistent AF episodes.

    Longstanding Persistent AF:

    Longstanding persistent AF is defined as continuous AF of greater than 12 months’ duration.

    Permanent AF:

    The term permanent AF is not appropriate in the context of patients undergoing catheter or surgical ablation of AF, as it refers to a group of patients for which a decision has been made not to restore or maintain sinus rhythm by any means, including catheter or surgical ablation. If a patient previously classified as having permanent AF is to undergo catheter or surgical ablation, the AF

    should be reclassified.

    Edit: Just noted that Hoogsteen et al also define paroxysmal as terminating within 7 days.

  • Thanks ectopic. Mine was persistent.

  • I guess mine is persistent afterall then.

  • Sounds like the numbers game. In order to keep the success rate high, only patients with a likelihood of success (however they calculate success) are offered ablation.

  • 100% ablation success after years of chronic AF (24/365) is known to be very difficult to achieve, esp after 1 ablation. Can you say who it was that performed it, and where was it done?

  • Hi gerryatriq, I don't like quoting personal names on the internet. If you want to know specifically, send me a message.

    My ablation was done by the QE Birmingham team. The EP said he was pretty confident that it would be successful because my AF was 24/7, so they would know straight away whether they had got it or not. He did say that there was a chance it might need repeating in 5-15 years time and it did, 10 years later. But they didn't actually ablate on the day because the AF had gone away and they couldn't even stimulate it, they were surprised by that. Still not got it now, two years on, just ectopics I think, not sure but it's very different.


  • Ps. I wasn't in chronic AF for years, more like months.

  • I was told not to take him over 120 but at rest with persistant AF rest hrm is over 100. I was trying to get back on the track sprinting so really frustrating. Now anything get AF symptoms haywire.

    However have a cardioversion next week so hopefully get something started.

    I was told to start walking but not the same once you've worn a number

  • I have lone AF (persistant) and am not on any meds. I exercise weekly now, a 5K run - which will build to 10K in the next few months. I think you need to separate the AF from the effects of any meds you may be under. These are fitness runs. I cant 'race' now - which was probably the cause of my AF to start with.

  • It was fitness jogging which I used to do earlier this year and I used to feel crap afterwards, that's how I date when I think my permanent AF began.

    I wasn't diagnosed until June though so wasn't on any meds until after then.

  • I believe I have paroxysmal afib. Haven't seen doctor since my monitor was removed. Initial diagnosis was "some" afib. I was biking 48-64K twice a week and swimming 1 1/2 K three times a week before my angina. Since having stents put in and these afib episodes kicking in more and more I'm averaging maybe half that with occasional problems, if I'm lucky.Some days I can do just fine others it's a struggle to get past the first few minutes of exercise(bike or swim). I started to keep a journal to log down what happens and when. No consistent pattern that I can see. Only meds I'm on are blood thinners. Go to see the electrocardiologist in a few weeks for my official visit after the monitor. Until they tell me I can't I'm going to keep trying and do the best I can.

  • I was told on Friday by my EP that I am Persistent, pretty much like ectopic described in his earlier post. When I'm not in AF I exercise like I did before getting AF. I was also told I have LONE AF, so I have no other underlying medical issues, so when not in AF I will train as I did before. When in AF I have to take it easy, as I get very breathless, but my heart rate does not rocket to figures some other people have on this forum. My EP has placed me on the ablation list. I have been on Amiodarone, that caused me thyroid problems and Flecainide that doesn't work too well, so for me to have a chance of getting back to my previous fitness regime with little interruption he suggests I be ablated. The odds he quoted me being in the persistent form I am now is between 60 - 70%. I asked was this for first time success, but he said overall. The odds aren't as good as I first thought.

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